Cross blood group transplants conducted in India

An organ transplant is not an easy job with the task of finding a compatible donor often proving arduous. A new device, however, removes the need for the donor to share the recipient’s blood group and two operations have already been successfully carried out at a Hyderabad hospital.

Cross blood group organ donations were impossible a few years back, but now the Swedish-developed device is set to change the perspective in organ donation. The procedure – at around Rs.10 lakh (approximately $20,000 ) – costs at least two-and-a-half times the normal transplants.

Developed by Swedish firm Glycorex, the device named Glycosorb ABO uses a procedure similar to kidney dialysis and “cleans” the blood to make transplant possible between people with different blood groups, by removing those antibodies which resist an organ of another blood group.

Explaining the device’s functioning, Glycorex’s Lars Hedbys says: “It brings down the antibodies (substances in blood responsible for immunisation against foreign bodies), which are responsible for resisting the other blood group.”

Hedbys was in Delhi recently for an exhibition at the Swedish embassy.

The human blood groups are A, B, O and AB, with positive or negative Rhesus factors (Rh). Blood group A has anti-B antibodies, group B has anti-A antibodies, group O has both anti-A and anti-B antibodies but the AB group has none. This makes AB groups universal receivers, which can accept blood or organs from any donor, while O is the universal donor.

The device works on a procedure called “immunoadsorption”, in which a dialyser column designed to “catch” only the relevant antibodies like anti-A group or anti-B group — which comprise only one to two percent of the total antibodies in plasma which is removed — thus sparing the “good” antibodies.

“The device has two columns, one removes the anti-A antibodies and the second the anti-B antibodies. Depending on the blood group, the necessary columns is used,” Hedbys told IANS.

Therefore, if the donor has blood group A, the A column is used to remove anti-A antibodies, for a donor of blood group B, anti-B antibodies are removed using the B column. The technique can be used for liver, kidney, lungs, stem cells, skin and even heart transplantation.

The first of such implants in India was done by doctors at Hyderabad’s Kamineni hospital in August this year.

“An ABO incompatible transplantation (non-matching blood groups) is the best option for a patient who has no compatible donors in the family and the waiting list is long,” said the hospital’s Kamal Kiran, who has already done two kidney transplant surgeries, from blood group A to O and AB to O.

The doctor said both were successful.

“Transplant patients walk on the second day of surgery, walk home on the seventh. Both patients have gone home and come to my clinic for a regular monthly checkup,” Kiran told IANS on phone from Hyderabad.

“The next surgery in line is from group B to O, and I have about 10 patients in line,” he said.

ABO-incompatibility was been a major handicap for transplants so far, he noted.

“Up to 30 percent of donors were deemed unsuitable earlier because of ABO incompatibility. ABO-incompatibility was an absolute contra-indication to transplantation,” says Kiran, adding the device has changed the scenario.

Across the world, ABO incompatible transplantation is being done cautiously in Sweden, Germany, the US and regularly in Japan. About 2,000 transplants have reportedly been carried out so far.

The cost difference between a normal transplant surgery and an ABO-incompatible implant is however huge, though it works out to be more economical in the long run.

“A normal ABO compatible transplant costs about Rs.3 to 4 lakh. An ABO-incompatible one costs Rs.10 lakh. This is due to the cost of the injections and the ABO columns which are expensive,” Kiran added.

The doctor, however, noted that the cost, specially in cases like kidney transplant, is cheaper than a long-term expense for treatments like dialysis.